Pediatric pancreatic trauma: predictors of nonoperative management failure and associated outcomes

Kelly D. Mattix, M. Tataria, J. Holmes, K. Kristoffersen, R. Brown, J. Groner, E. Scaife, D. Mooney, M. Nance, L. Scherer

Research output: Contribution to journalArticle

77 Citations (Scopus)

Abstract

Background: Nonoperative management (NOM) is an accepted treatment of pediatric solid organ injuries and is typically successful. Blunt pancreatic trauma tends to require operative intervention more frequently. We sought to identify predictors of failure of NOM and compare the outcome of operative management against NOM. Methods: A retrospective analysis was performed from January 1993 to December 2002 of all children with blunt pancreatic injuries from the trauma registries of 7 designated level 1 pediatric trauma centers. Failure of NOM was defined as the need for intraabdominal operative intervention. Injuries were graded I to V, and ductal injury was defined as grades III to V. Parameters included mechanism of injury, injury severity score (ISS), organ grade, Glasgow Coma Scale score, and outcome. Data were analyzed by Fisher exact test and Mann-Whitney U test, with mean values ± SD and significance of P < .05. Results: Pancreatic injuries were present in 173 (9.2%) of 1823 patients. Of these, 43 (26.0% [43/173]) required an operation. Valid morbidity data was obtained in 118 of 173 patients. ISS was significantly higher in all patients treated operatively. Patients with an injury of grade III to V failed NOM more frequently than all patients with pancreatic injury (P =.0169). Length of stay was longer, and the incidence of pseudocysts, drainage procedures, and pancreatitis was higher in NOM patients, although not significant. Conclusions: Patients with pancreatic injuries had a NOM failure rate of 26.0%. ISS and injury grades III to V were predictors of NOM failure. Patients with pancreatic ductal injury require more aggressive management.

Original languageEnglish
Pages (from-to)340-344
Number of pages5
JournalJournal of Pediatric Surgery
Volume42
Issue number2
DOIs
StatePublished - Feb 2007

Fingerprint

Pediatrics
Wounds and Injuries
Injury Severity Score
Nonpenetrating Wounds
Glasgow Coma Scale
Trauma Centers
Nonparametric Statistics
Pancreatitis
Registries
Drainage
Length of Stay
Morbidity
Incidence

Keywords

  • Nonoperative management
  • Pancreatic injury
  • Pediatric trauma
  • Pseudocyst

ASJC Scopus subject areas

  • Surgery

Cite this

Mattix, K. D., Tataria, M., Holmes, J., Kristoffersen, K., Brown, R., Groner, J., ... Scherer, L. (2007). Pediatric pancreatic trauma: predictors of nonoperative management failure and associated outcomes. Journal of Pediatric Surgery, 42(2), 340-344. https://doi.org/10.1016/j.jpedsurg.2006.10.006

Pediatric pancreatic trauma : predictors of nonoperative management failure and associated outcomes. / Mattix, Kelly D.; Tataria, M.; Holmes, J.; Kristoffersen, K.; Brown, R.; Groner, J.; Scaife, E.; Mooney, D.; Nance, M.; Scherer, L.

In: Journal of Pediatric Surgery, Vol. 42, No. 2, 02.2007, p. 340-344.

Research output: Contribution to journalArticle

Mattix, KD, Tataria, M, Holmes, J, Kristoffersen, K, Brown, R, Groner, J, Scaife, E, Mooney, D, Nance, M & Scherer, L 2007, 'Pediatric pancreatic trauma: predictors of nonoperative management failure and associated outcomes', Journal of Pediatric Surgery, vol. 42, no. 2, pp. 340-344. https://doi.org/10.1016/j.jpedsurg.2006.10.006
Mattix, Kelly D. ; Tataria, M. ; Holmes, J. ; Kristoffersen, K. ; Brown, R. ; Groner, J. ; Scaife, E. ; Mooney, D. ; Nance, M. ; Scherer, L. / Pediatric pancreatic trauma : predictors of nonoperative management failure and associated outcomes. In: Journal of Pediatric Surgery. 2007 ; Vol. 42, No. 2. pp. 340-344.
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N2 - Background: Nonoperative management (NOM) is an accepted treatment of pediatric solid organ injuries and is typically successful. Blunt pancreatic trauma tends to require operative intervention more frequently. We sought to identify predictors of failure of NOM and compare the outcome of operative management against NOM. Methods: A retrospective analysis was performed from January 1993 to December 2002 of all children with blunt pancreatic injuries from the trauma registries of 7 designated level 1 pediatric trauma centers. Failure of NOM was defined as the need for intraabdominal operative intervention. Injuries were graded I to V, and ductal injury was defined as grades III to V. Parameters included mechanism of injury, injury severity score (ISS), organ grade, Glasgow Coma Scale score, and outcome. Data were analyzed by Fisher exact test and Mann-Whitney U test, with mean values ± SD and significance of P < .05. Results: Pancreatic injuries were present in 173 (9.2%) of 1823 patients. Of these, 43 (26.0% [43/173]) required an operation. Valid morbidity data was obtained in 118 of 173 patients. ISS was significantly higher in all patients treated operatively. Patients with an injury of grade III to V failed NOM more frequently than all patients with pancreatic injury (P =.0169). Length of stay was longer, and the incidence of pseudocysts, drainage procedures, and pancreatitis was higher in NOM patients, although not significant. Conclusions: Patients with pancreatic injuries had a NOM failure rate of 26.0%. ISS and injury grades III to V were predictors of NOM failure. Patients with pancreatic ductal injury require more aggressive management.

AB - Background: Nonoperative management (NOM) is an accepted treatment of pediatric solid organ injuries and is typically successful. Blunt pancreatic trauma tends to require operative intervention more frequently. We sought to identify predictors of failure of NOM and compare the outcome of operative management against NOM. Methods: A retrospective analysis was performed from January 1993 to December 2002 of all children with blunt pancreatic injuries from the trauma registries of 7 designated level 1 pediatric trauma centers. Failure of NOM was defined as the need for intraabdominal operative intervention. Injuries were graded I to V, and ductal injury was defined as grades III to V. Parameters included mechanism of injury, injury severity score (ISS), organ grade, Glasgow Coma Scale score, and outcome. Data were analyzed by Fisher exact test and Mann-Whitney U test, with mean values ± SD and significance of P < .05. Results: Pancreatic injuries were present in 173 (9.2%) of 1823 patients. Of these, 43 (26.0% [43/173]) required an operation. Valid morbidity data was obtained in 118 of 173 patients. ISS was significantly higher in all patients treated operatively. Patients with an injury of grade III to V failed NOM more frequently than all patients with pancreatic injury (P =.0169). Length of stay was longer, and the incidence of pseudocysts, drainage procedures, and pancreatitis was higher in NOM patients, although not significant. Conclusions: Patients with pancreatic injuries had a NOM failure rate of 26.0%. ISS and injury grades III to V were predictors of NOM failure. Patients with pancreatic ductal injury require more aggressive management.

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